Despite the proven benefits of antiviral treatments in preventing severe COVID-19, a new study reveals that these medications are being underprescribed to older adults, the population most vulnerable to the virus’s serious complications. Researchers found that only 31% of outpatients aged 65 and older received an antiviral prescription following a positive COVID-19 diagnosis between June 2023 and September 2025. This concerning trend highlights a gap in care that could be contributing to preventable hospitalizations and deaths, particularly as the virus continues to evolve and circulate.
The study, published in the Morbidity and Mortality Weekly Report, analyzed data from over 482,000 outpatient encounters. It underscores the importance of timely access to antiviral therapies like nirmatrelvir/ritonavir (Paxlovid), remdesivir (Veklury) and molnupiravir, which have demonstrated effectiveness in reducing the risk of severe illness when administered early in the course of infection. Understanding the factors influencing prescribing patterns is crucial to improving treatment rates and protecting older adults from the worst outcomes of COVID-19.
Disparities in Antiviral Access
The analysis revealed significant variations in antiviral prescribing based on several demographic and clinical factors. Increasing age was associated with a slightly higher likelihood of receiving treatment, with those aged 75 to 84 and 85 and older demonstrating increased odds compared to those aged 65 to 74. Yet, racial and ethnic disparities were also evident. Asian patients were 1.42 times more likely to receive an antiviral prescription compared to non-Hispanic White patients, while Hispanic or Latino patients had a 1.24 times higher likelihood. A recent CDC report emphasizes the ongoing need to address health inequities in COVID-19 care.
Vaccination status also played a significant role. Patients who had received at least one COVID-19 vaccine dose within the prior six months were 1.73 times more likely to be prescribed an antiviral. This suggests that individuals who are proactively engaged in preventative healthcare measures are also more likely to receive timely treatment when infected. Conversely, the presence of comorbidities—existing health conditions—was associated with *lower* odds of antiviral prescribing. Patients with one comorbidity were 24% less likely to receive treatment, and those with two or more were 25% less likely.
Fluctuating Prescribing Trends and Geographic Differences
Prescribing rates weren’t consistent throughout the study period. While rates hovered between 36.7% and 37.6% during the summers of 2023 and 2024, they declined significantly during other periods, dropping to as low as 16.5% in the spring of 2025. These fluctuations appeared to correlate with changes in SARS-CoV-2 circulation, suggesting that perceptions of community transmission levels may influence prescribing decisions. The investigators noted that healthcare providers may be less inclined to prescribe antivirals when COVID-19 cases are perceived as low.
Geographic location also impacted access to antiviral treatment. Patients residing in rural areas were less likely to receive a prescription—81% the odds of those in urban areas—potentially due to limited access to healthcare facilities or differing local prescribing practices. This disparity underscores the need for targeted interventions to ensure equitable access to care for all populations, regardless of location.
The Role of Nirmatrelvir/Ritonavir
Nirmatrelvir/ritonavir (Paxlovid) was by far the most commonly prescribed antiviral, accounting for 80% of all prescriptions. Molnupiravir accounted for 13%, while remdesivir was prescribed in 7% of cases. This preference for Paxlovid aligns with its demonstrated efficacy and relatively convenient oral administration. However, it’s important to note that Paxlovid has potential drug interactions, which may influence prescribing decisions for some patients.
Addressing the Gap in Care
The study’s findings emphasize the urgent need for public health initiatives aimed at improving both healthcare provider and patient knowledge regarding the benefits of COVID-19 vaccination and antiviral treatments. Efforts should focus on educating providers about the latest treatment guidelines and addressing potential barriers to prescribing, such as concerns about drug interactions or logistical challenges. Simultaneously, public awareness campaigns can empower patients to advocate for timely treatment if they test positive for COVID-19.
The investigators acknowledge several limitations to their study, including the potential for underascertainment of COVID-19 cases and the lack of data on symptom severity, which could influence treatment eligibility. However, the large sample size and comprehensive data analysis provide valuable insights into prescribing patterns and highlight the critical need to address disparities in access to antiviral therapies. The CDC continues to monitor COVID-19 antiviral prescription receipt and provide updated guidance to healthcare professionals.
As the virus continues to circulate and new variants emerge, ensuring equitable access to effective treatments remains paramount. The next data release from the CDC regarding COVID-19 antiviral utilization is expected in late spring 2026, which will provide further insights into evolving trends and the impact of ongoing interventions.
Have you discussed COVID-19 antiviral options with your healthcare provider? Share your thoughts and experiences in the comments below.
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